Design Therapy

By Carol Tisch • Cover and portrait photography by Chris ConeA sea change in the way people look at healthcare design is revolutionizing the industry. Tending mind, body and spirit is no longer the exclusive conundrum of holistic medicine, and cutting-edge firms like Maregatti Interiors are tackling the healing triumvirate through evidence-based design.

By Carol Tisch

A sea of change in the way people look at healthcare design is revolutionizing the industry. Tending mind, body and spirit is no longer the exclusive conundrum of holistic medicine, and cutting- edge firms like Maregatti Interiors are tackling the healing triumvirate through evidence-based design.

The truth of the matter is that design therapy works. Through its alliance with giant BSA LifeStructures, Indianapolis-based Maregatti Interiors presents clients with concrete research that quantifies the benefits of healing environments. And healthcare institutions are buying into the concept across the country's heartland, not just on the swanky East and West Coasts. An increasing number of case studies, accompanied by numerous success stories, reveal reduced patient error, improved productivity, greater worker and patient satisfaction, and quicker healing timesall through better design.

Therapeutic interior environments aren't really new; in fact Ana Maregatti, president of Maregatti Interiors, says she has been influenced by the work of pioneer Jain Malkin, president of the eponymous interior architecture firm, and author of books on life-enhancing hospital interiors. A side benefit to breakthrough designs in the industry is that more talented young designers are attracted to healthcare than ever before, according to Maregatti's partner, Scott McFadden, vice president and director of design.

"We've come a long way in healthcare," McFadden says. "There are many firms out there contributing to the change, but I can tell you that when I started working in healthcare architecture back in 1990, it was very cold and very institutional. It wasn't a terribly exciting field at that point in time."

The partners agree that the business of healthcare design changed for the better when clients' focus shifted to consumers' wants and needs. "There are two reasons," Maregatti explains. "One is the increase in competition between healthcare facilities, and the other is the Baby Boomer generation wanting to make choices, including where they go for medical treatment. Healthcare facilities are using design almost as a recruiting and retaining toolfor patients, staff and caregivers."

"I really love working in healthcare now, because I feel like we are making a difference for peopleobviously for the patients, but also for the families and the people who live and breathe and work in those facilities every day," McFadden adds.

"We try to bring significance to these projects," says Maregatti. "And we're most proud of our work when evidence shows it makes a difference." Through a range of diverse projects, Maregatti Interiors employs primary research to pinpoint the path to user satisfaction. "The retail industry gets who their customers are; and the hospitality industry knows who they are designing for," she adds. "The healthcare industry is now 'getting' their customer too. "We do a lot of research with the patients, asking what they want a room to be, whether it's a patient room, an X-ray room, a lounge (etcetera)," Maregatti says. But the research isn't simply canned for reuse, according to McFadden. "The challenge is not just repeating the same thing. You have to make sure the design response is right for its particular environment and its particular patient type."

Maregatti points to the Riley Hospital for Children in Indianapolisone of the largest, most comprehensive outpatient pediatric facilities in the country. Her firm will apply what it learns from interviewing these patients to the interior of an 800,000-sq. ft. addition which will almost double the size of the current facility. "Children are so much more honest in their positioning; they really open up to what will make a difference to them," she says. Research with kids at Riley showed the Maregatti Interiors team that pediatric rooms can't be lumped under one umbrella. "If you're a teenager, your needs are totally different than if you're a toddler. We find out about the family members, about how we can create rooms that help parents and siblings better support the patient," Maregatti says. "When we've designed a space that helps them, then we feel we've delivered a project with significance."

A quick glance at some of the firm's other projects can sometimes elicit a double-take. You could be looking at a fine dining establishment instead of a hospital cafeteria, a high-end spa instead of a delivery room, a four-star resort atrium instead of healthcare facility's lobby. And that's a good thing, the designers say, because that's what makes healthcare venues less threatening, more healing, and ultimately more financially successful.

"People spend more time in the rest of the world than they do in hospitals, so they feel more comfortable in environments that they can relate to home or vacation experiences," McFadden explains. Indeed, recent award-winning projects by Maregatti Interiors for the Hansen Center of Margaret Mary Community Hospital and for Clarian Health Partners throughout Indiana (notably Clarian West Medical Center) showcase groundbreaking design innovations. The newly completed Clarian North Medical Center raises the bar even further.

But to achieve that award-winning balance between healthcare and the outside world, designers say they needed to break out of the healthcare mold. "Diversity of projects helps in healthcare design," says McFadden, who like Maregatti had been an employee of BSA LifeStructures before the interior design group split off into a separate company. Like a nurturing parent who knows when to let go, BSA LifeStructures became the creative muse of 13 designers by supporting the formation of Maregatti Interiors in 2002. The fledgling company took off, grew to a staff of 20, with half of their projects now coming from independent clients.

"BSA LifeStructures is a partner in our business, and 50 percent of our work is through BSA LifeStructures," Maregatti says. "But by being a separate company, we were able to branch out into other areas of design. Having the opportunity to work on other types of projects, to bring other thoughts and feelings into our hospitals, makes them more comfortable and less threatening."

Projects outside the field of healthcare include award-winning corporate offices for athletic apparel and shoe retailer, Finish Line, now 600 stores strong. McFadden says the interior design took its lead from the company's branding. "Their mission statement is 'Addiction to Action,' so we looked for ways to incorporate the movement associated with a finish line throughout the facility. Circles, as well as movement and changing colors, plays off the image of a winning circle," he explains.

The partners point out that the hottest trends in healthcare environments encompass both the practical and the aesthetic. "Technology in the patient room is a big issue," McFadden reports. He cites new uses of in-room computer monitors suspended from ceilings that are used by patients in conjunction with wireless keyboard trays.

"Patients use the computers to get their daily schedules; they know what to expect, and that helps lower anxiety," he says. "They now have the opportunity to order their own meals, choose whatever they like, even have food delivered whenever they want. And hospitals now give them access to the Internet, so they can play games, e-mail and feel a little more connected to the world."

But cutting-edge technology also has a downside. Some equipment is often downright scary, like the futuristic-looking linear accelerator used at another award-winning projectthe Hansen Center in Batesville, IN. "Radiation areas tend to be pretty threatening places because the concrete walls are (up to) four feet thick to contain the radiation. We were able to minimize the maze patients usually walk through to get to this equipment, and make the corridor leading to this room appear shorter," McFadden explains.

Once inside, patients are introduced to positive distractions. Maregatti Interiors hired a photographer to take about 30 different images of local and Southwestern scenes that hang on two of the room's walls, "so patients could think of another time or place, or something to look forward to while in the room," McFadden adds. Incandescent lighting and wood panels were also used to soften the space.

Before the Hansen Center was built, people who lived in the area had to travel one or two hours to larger cities for these treatments, the designers say. One of the design mandates was to bring these services to the community in a non-threatening way. "When you walk into the space, it is very warm and inviting," Maregatti says. "We used natural stone, natural woods, wood floors and carpeted family rooms. There's a lot of natural light with large windows to a 50-acre site with a lake and a lot of healing gardens."

Healing gardens are also 'distractions,' which is now a buzzword in progressive healthcare design. "We are now focused on finding things for people to do in the hospital setting," McFadden explains. "The traditional waiting room is not really acceptable anymore. Now a waiting space is more of a family room, with kitchens and laundry facilities, computer areas and media centers.

"Whether it's a spouse or children or other family members attending a patient, they still need to make their lives work: whether they're trying to keep their business afloat or just wanting to keep from being bored," he adds.

While most of those issues are addressed in the patient units, McFadden says that in public spaces, even more activities for visitors and family need to be provided. "In some respects, the big public spaces are modeled after a shopping mall: with some retail spaces and dining spaces that provide choices," he says. As an example, he mentions that the blockbuster restaurant the firm created at the Clarian North Medical Center was just the beginning. "That's where we were two-and-a-half years ago. The projects we have on the board right now are moving even further than this."

One project currently in the works is Lakeland Hospital in St. Joseph, MI. "Of all the zones we refer to in healthcare design, the family zone is changing most and becoming much more comfortable," McFadden says. In Lakeland Hospital the family space will include large sofas that open into comfortable, twin size beds, as well as height-adjustable, mobile tables so family members can eat meals or work at their computers.

"We have a large flat screen TV for the patient, but we'll also have a small LCD screen for the family member. Cubicle curtains will provide a little more privacy, and we're looking at creating something a bit more architectural to divide up the patient and family zones," he says. Safety, which is always a major area of concern, is also being addressed in new ways for Lakeland Hospital. Patient room toilets will be close to the bed to reduce falls (where 80 percent of hospital falls occur). Maregatti Interiors also created innovative secondary restroom doors that open 360 degrees. From noise reduction and the decentralization of nursing stations, to the use of bright colors believed to encourage hope, the team at Maregatti Interiors is on the forefront of healthcare design. "Every project we work on teaches us more and more," Maregatti concludes. "We're always trying to figure out what's next, how we can bring more to the table, and be more innovative than we were before."